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The main goal of cholesterol-lowering treatment is to lower your LDL level enough to reduce your risk of developing heart disease or having a heart attack. The higher your risk, the lower your LDL goal will be. To find your LDL goal, see the box for your risk category below. There are two main ways to lower your cholesterol:

* Therapeutic Lifestyle Changes (TLC)-includes a cholesterol-lowering diet (called the TLC diet), physical activity, and weight management. TLC is for anyone whose LDL is above goal.
* Drug Treatment-if cholesterol-lowering drugs are needed, they are used together with TLC treatment to help lower your LDL.

If you are in…

Category I, High Risk, your LDL goal is less than 100 mg/dL. You will need to begin the TLC diet to reduce your high risk even if your LDL is below 100 mg/dL. If your LDL is 100 mg/dL or above, you will need to start drug treatment at the same time as the TLC diet. If your LDL is below 100 mg/dL, you may also need to start drug treatment together with the TLC diet if your doctor finds your risk is very high, for example if you have had a recent heart attack or have both heart disease and diabetes.

Category II, Next Highest Risk, your LDL goal is less than 130 mg/dL. If your LDL is 130 mg/dL or above, you will need to begin treatment with the TLC diet. If your LDL is 130 mg/dL or more after 3 months on the TLC diet, you may need drug treatment along with the TLC diet. If your LDL is less than 130 mg/dL, you will need to follow the heart-healthy diet for all Americans, which allows a little more saturated fat and cholesterol than the TLC diet.

Category III, Moderate Risk, your LDL goal is less than 130 mg/dL. If your LDL is 130 mg/dL or above, you will need to begin the TLC diet. If your LDL is 160 mg/dL or more after you have tried the TLC diet for 3 months, you may need drug treatment along with the TLC diet. If your LDL is less than 130 mg/dL, you will need to follow the heart-healthy diet for all Americans.

Category IV, Low-to-Moderate Risk, your LDL goal is less than 160 mg/dL. If your LDL is 160 mg/dL or above, you will need to begin the TLC diet. If your LDL is still 160 mg/dL or more after 3 months on the TLC diet, you may need drug treatment along with the TLC diet to lower your LDL, especially if your LDL is 190 mg/dL or more. If your LDL is less than 160 mg/dL, you will need to follow the heart-healthy diet for all Americans.

To reduce your risk for heart disease or keep it low, it is very important to control any other risk factors you may have such as high blood pressure and smoking.

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A similar diabetes drug, Actos, doesn’t seem to carry same dangers, study finds

The widely used diabetes drug Avandia — already controversial because of cardiovascular side effects — may be riskier than Actos, another drug in the same class, researchers reported Monday.

The risk of heart failure and death for older diabetics appears greater with Avandia (rosiglitazone) than with Actos (pioglitazone), both of which are part of a class of drugs called thiazolidinediones, Harvard University researchers said.

Avandia and Actos are used to lower blood sugar in patients with type 2 diabetes. Recent studies suggested that the risk for heart failure, death and heart attack were increased with Avandia, touching off a controversy that resulted in new FDA-mandated label warnings about the drug.

“By contrast, Actos did not appear to increase the risk of cardiac events,” said lead researcher Dr. Wolfgang C. Winkelmayer, an assistant professor of medicine at Harvard Medical School. “One could get the impression that Actos led to the reduction of heart attacks.”

Indirectly, people inferred that it might be better to use Actos, because Avandia has cardiovascular risks associated with it, Winkelmayer said.

“We did find that patients using rosiglitazone actually had an increased risk of mortality from any cause. We did not find a difference in heart attacks and strokes,” Winkelmayer said. But, he added, more patients taking Avandia were hospitalized for heart failure.

Winkelmayer noted differences in drugs in the same class are not unusual. For example, cholesterol-lowering statins (which include Crestor, Lipitor and Zocor) have different side effects, he said.

The new research, published in the Nov. 24 issue of the Archives of Internal Medicine, received funding from the American Heart Association, as well drug makers Amgen and GlaxoSmithKline, which makes Avandia.

For the study, Winkelmayer’s team collected data on more than 28,000 diabetic patients aged 65 and older who were taking Avandia or Actos between 2000 and 2005. Among these patients, 50.3 percent took Actos and 49.7 percent took Avandia.

After a little more than a year on the medications, 1,869 patients died. The researchers found that patients taking Avandia had a 15 percent higher rate of death compared with patients taking Actos. In addition, Avandia patients had a 13 percent greater risk of heart failure than patients on Actos.

GlaxoSmithKline defended its drug in a statement on the new research released Monday.

The company “strongly supports the safety and efficacy of Avandia based on extensive clinical trial experience and widespread post-marketing use. This new study is inconsistent with evidence from randomized clinical trials and has significant limitations,” the statement said.

A randomized clinical trial — in which participants are randomly grouped and then followed prospectively over time — is typically considered more reliable than an observational study, which is not as well-controlled.

“The primary outcome in this observational analysis is all-cause mortality,” the company statement added. “The Avandia prescribing information includes data from RECORD, an ongoing long-term randomized clinical trial that has shown no statistically significant differences between the Avandia group and the control group regarding death from cardiovascular causes or any cause.”

The continuing controversy over the heart risks of these diabetes drugs began with a 2007 study, published in the New England Journal of Medicine, in which heart expert Dr. Steven E. Nissen, chairman of the Cleveland Clinic’s department of cardiovascular medicine, reported a 43 percent increased risk of heart attack among patients taking Avandia.

In November 2007, the U.S. Food and Drug Administration said that GlaxoSmithKline had agreed to add to the existing “black box” a new warning about the potential increased risk for heart attacks. Previously, the FDA had requested that GlaxoSmithKline and Takeda Pharmaceuticals, the maker of Actos, add a “black box” warning about the increased risk of heart failure associated with both drugs.

In July 2008, an FDA advisory panel said that drugs designed to control type 2 diabetes, including Avandia, should be subjected to more thorough safety reviews to ensure they don’t raise the risk of heart problems. They recommended that all makers of these drugs conduct long-term cardiovascular trials, even if the drugs show no signs of heart problems in initial trials.

But Winkelmayer believes that neither Avandia nor Actos should be used as initial treatment. When they are used, they should be used with caution, especially with patients prone to heart problems, he said.

Dr. Eric J. Topol, director of the Scripps Translational Science Institute and chief academic officer at Scripps Health in La Jolla, Calif., also thinks both drugs should be used cautiously.

“The study reinforces the heart failure risk of rosiglitazone versus pioglitazone,” Topol said. “Interestingly, it doesn’t show any difference in heart attack, which is the one issue that has been so controversial. So it doesn’t really change things that much.”

Of the two drugs, Actos appears to have a more favorable track record, Topol added. “But the possibility of cardiovascular side effects, including heart failure and heart attack, can’t be forgotten.”

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The globe artichoke is one of the oldest known cultivated vegetables, originating from Ethiopia, with Italy currently being the world’s largest producer.

It was valued in ancient Greece and Rome as a digestive aid, available only to the wealthy due to its scarcity.

It was the French and Spanish explorers who fist brought artichokes to the shores of the United States, and today virtually all of the globe artichokes grown in the US are produced in Castroville, California.

Health Benefits of Artichokes

* Nutrients
Globe artichokes are an excellent source of dietary fiber, magnesium, and the trace mineral chromium. They are a very good source of vitamin C, folic acid, biotin, and the trace mineral manganese. They are a good source of niacin, riboflavin, thiamin, vitamin A, and potassium.

* Cholesterol
There have been numerous studies on artichoke extract ever since European scientists first discovered cynarin’s ability to lower cholesterol in the 1970’s. Caffeoylquinic acids, such as cynarin are the active ingredients in artichokes that lower cholesterol, with higher concentrations in the leaves. A 6 week double blind, placebo controlled clinical trial of 143 patients has demonstrated without a doubt to the effectiveness of artichoke leaf extract for lowering cholesterol. The decrease of total cholesterol in the group that received the extract was 18.5% compared to 8.6% in for the placebo group. LDL-cholesterol decrease in the AE group was 22.9% and 6.3% for placebo. LDL/HDL ratio showed a decrease of 20.2% in the AE group and 7.2% in the placebo group.. A compound found in artichoke called luteolinis is also believed to assist with reducing cholesterol.

* Irritable bowel syndrome
In a trial involving 208 adults, results provide support for the notion that artichoke leaf extract has potential value in relieving IBS symptoms.

* Indigestion
In a double-blind trial, 247 patients with dyspepsia (digestive problems) were treated with artichoke leaf extract, and the results demonstrated an improvement in their dyspeptic symptoms. Dyspepsia is often attributed to insufficient flow of bile from the gallbladder, and there is evidence that artichoke leaf has the ability to stimulate this flow.

* Diabetes
The carbohydrate in artichokes is in the form of inulin, which has been shown to stabilize blood sugar levels in diabetics. The artichokes must be fresh, as the inulin will eventually convert to other sugars as the artichoke ages.

* Hangovers
Contrary to what some would like to believe, a study demonstrated the ineffectiveness of artichoke extract in the cure of alcohol-induced hangovers.

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In order to function properly, your heart needs a large and continuous stream of oxygen-enriched blood, which is supplied directly to your heart muscle through your coronary arteries. If your coronary arteries become clogged, blocked, inflamed, infected, or injured, the blood flow to your heart will be reduced, which can cause injury to your heart muscle and in turn lead to heart disease or cardiovascular disease (CVD). Some of the more common outcomes of heart disease include myocardial infarction, ischemic heart disease and angina, and arrhythmias.

General risk factors for heart disease

Those you can’t change:

* Family history: Genetic predisposition can play a role in the development of heart disease. Your doctor will want to know if you have a family history of heart disease.
* Age: Wear and tear on your body is cumulative. The heart is no exception. The older you are, the more wear and tear your system will have and the greater the risk of your system not functioning as it did when you were younger.

Those you can change:

* Smoking: Smoking reduces the blood’s oxygen level, injures artery walls, and raises your heart rate and blood pressure.
* High-fat diet: Diets high in fat, especially saturated fats, increase the risk of fatty buildup in the arteries.
* High blood cholesterol: Cholesterol is a fatty substance required by your body to make cells. But your body only needs a certain amount. High blood cholesterol can cause arteriosclerosis.
* Physical inactivity: Regular exercise helps to strengthen your heart muscle and keep it in good working order.
* Hypertension or high blood pressure: Hypertension means your blood is hitting too hard against your artery walls. High blood pressure can increase your risk of stroke, aneurysm, heart failure, heart attack, and kidney damage.
* Obesity: Being significantly overweight or obese increases your blood pressure, causing your heart to work too hard on less oxygen, and it increases your risk of diabetes.
* Stress: Stress increases your heart rate and blood pressure, which in turn causes damage to your arteries and heart.
* Diabetes: Men with sugar diabetes (diabetes mellitus) have 3 or 4 times the likelihood of developing atherosclerosis, resulting in angina, heart attacks, strokes, or peripheral vascular disease. Women with diabetes are at an even higher risk - probably 4 times that of non-diabetic women.

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Do not consumption this medication if you are sensitised to lipitor, if you are meaning or nursing, or if you stimulate liver disease.

Before taking Lipitor, tell your doctor if you ar allergic to any drugs, or if you have:

* diabetes;
* underactive thyroid;
* kidney disease; or
* a muscleman disorder.

If you have any of these weather, you crataegus laevigata need a dose accommodation or special tests to safely take Lipitor.

FDA gestation category X. This medication can case birth defects. Do not use Atorvastatin if you are significant. Tell your doctor right away if you become pregnant during treatment. Role an effectual form of birth control while you are victimisation this medicinal drug. Lipitor can make birth control pills less effective. Ask your doctor around using a non-hormone method of parturition control (such as a condom, diaphragm, spermicide) to prevent gestation while taking Lipitor. It is not known whether Lipitor passes into chest milk or if it could damage a nursing baby. Do not take Lipitor without telling your doctor if you are breast-feeding a baby. Lipitor is not for manipulation in children younger than 10 long time of old age.

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In uncommon cases, Atorvastatin can causal agent a condition that results in the breakdown of skeletal brawn tissue. This condition canful lead to kidney failure. Call your doctor at once if you experience unexplained muscle pain or tenderness, muscular tissue weakness, fever or influenza symptoms, and dark colorful urine. This medication rump cause birth defects in an unborn baby. Do not habit if you are significant. Use an effective form of nativity control, and tell your doctor if you suit pregnant during treatment. Do not contract Lipitor if you are pregnant or breast-feeding, or if you have liver disease.

Before taking Lipitor, distinguish your doctor if you have diabetes, underactive thyroid, kidney disease, a muscle disorder, or a blood disorder:

Avoid eating foods that are high in fat or cholesterol. Lipitor will not be as effective in lowering your cholesterol if you do not follow a cholesterol-lowering diet plan.

Forefend drinking alcoholic drink while pickings Lipitor. Alcohol can raise triglyceride levels, and english hawthorn also price your liver while you are taking Lipitor.

There may be early drugs that can interact with Lipitor. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

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